Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, California, USA.
Vector Borne Zoonotic Dis. 2011 Nov;11(11):1503-5. doi: 10.1089/vbz.2010.0169. Epub 2011 Jun 24.
The diagnosis of infective endocarditis can be difficult, particularly with atypical presentation and negative blood cultures. A 61-year-old man with a porcine aortic valve presented with fever, intermittent confusion, diarrhea, and fatigue. In the community clinic setting, a colonoscopy performed for anemia demonstrated colitis. Symptoms progressed for months; elicitation of a history of significant kitten exposure and the finding of an axillary lymph node prompted testing for Bartonella henselae antibodies. High titer antibodies by indirect immunofluorescence assay indicated chronic B. henselae infection. Surgical valve replacement followed by prolonged doxycycline and rifampin led to cure. This case illustrates the complexities of infective endocarditis and is the first description B. henselae endocarditis associated with colitis in an immunocompetent adult.
感染性心内膜炎的诊断可能较为困难，尤其是对于不典型表现和阴性血培养的患者。一位 61 岁男性，主动脉瓣为猪瓣，表现为发热、间歇性意识模糊、腹泻和乏力。在社区诊所就诊时，因贫血而行结肠镜检查提示结肠炎。症状持续数月；因有大量小猫接触史，且发现腋窝淋巴结，因此检测了汉赛巴尔通体抗体。间接免疫荧光法检测到高滴度抗体，提示慢性汉赛巴尔通体感染。随后行手术瓣膜置换，并长期使用多西环素和利福平治疗，最终治愈。本例说明了感染性心内膜炎的复杂性，也是首例描述免疫功能正常成人汉赛巴尔通体感染性心内膜炎合并结肠炎的病例。
